title: Beyond fasting plasma glucose: the association between coronary heart disease risk and postprandial glucose, postprandial insulin and insulin resistance in healthy, nondiabetic adults.
abstract: OBJECTIVE
  Prediabetes is defined by elevations of plasma glucose concentration, and is aimed at identifying individuals at increased risk of type 2 diabetes and coronary heart disease (CHD). However, since these individuals are also insulin resistant and hyperinsulinemic, we evaluated the association between several facets of carbohydrate metabolism and CHD risk profile in apparently healthy, nondiabetic individuals.
  
  
  METHODS
  Plasma glucose and insulin concentrations were measured before and at hourly intervals for eight hours after two test meals in 281 nondiabetic individuals. Insulin action was quantified by determining the steady-state plasma glucose (SSPG) concentration during the insulin suppression test. CHD risk was assessed by measurements of blood pressure and fasting lipoprotein profile.
  
  
  RESULTS
  For purposes of analysis, the population was divided into tertiles, and the results demonstrated that the greater the 1) fasting plasma glucose (FPG) concentration, 2) incremental plasma insulin response to meals, and 3) SSPG concentration, the more adverse the CHD risk profile (p<0.05). In contrast, the CHD risk profile did not significantly worsen with increases in the incremental plasma glucose response to meals.
  
  
  CONCLUSIONS
  In nondiabetic individuals, higher FPG concentrations, accentuated daylong incremental insulin responses to meals, and greater degrees of insulin resistance are each associated with worse CHD risk profile (higher blood pressures, higher triglycerides, and lower high density lipoprotein cholesterol concentrations). Interventional efforts aimed at decreasing CHD in such individuals should take these abnormalities into consideration.
authors.affiliation: Stanford University School of Medicine Stanford, CA 94305, USA. slbhat@stanford.edu
authors.forename: Shubha L
authors.initials: SL
authors.lastname: Bhat
authors.forename: Fahim A
authors.initials: FA
authors.lastname: Abbasi
authors.forename: Christine
authors.initials: C
authors.lastname: Blasey
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Reaven
authors.forename: Sun H
authors.initials: SH
authors.lastname: Kim
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D003327:Coronary Disease / Q000097:blood / Q000209:etiology*; D005215:Fasting / Q000097:blood*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D019518:Postprandial Period / Q000502:physiology*; D012307:Risk Factors
chemical_list: D001786:Blood Glucose
keywords: CHD; Carbohydrate metabolism; Coronary Heart Disease; FPG; Fasting Plasma Glucose; HDL-C; High-Density Lipoprotein-Cholesterol; Hyperglycemia; Hyperinsulinemia; LDL-C; Low-Density Lipoprotein-Cholesterol; SSPG; Steady State Plasma Glucose